Operative Treatment for Fourth Curly Toe Deformity

NewsBot · Apr 10, 2015

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Operative Treatment for Fourth Curly Toe Deformity in Adults
Jun Young Choi, Hyun Joo Park, Jin Soo Suh
Foot & Ankle International April 9, 2015

Background: Curly toe deformity, a relatively common condition, occurs because of contracture of the flexor digitorum longus and flexor digitorum brevis. Numerous operative techniques have been introduced for treatment. However, there are no reports on fixed, longstanding deformity in adults.
Methods: Data on 32 toes in 24 consecutive patients treated from 2003 to 2013 who underwent dorsolateral closing wedge-shaped resection arthroplasty for fourth curly toe deformity with a minimum 1-year follow-up were reviewed retrospectively. The mean follow-up period was 49 months. All patients presented preoperatively with a fixed deformity, underriding the adjacent toe. Combined surgeries were performed in 17 cases.
Results: Of 32 toes, fixed deformity presented more frequently at the proximal interphalangeal (PIP) joint, and resection at the PIP joint level was performed in 19 cases as opposed to 13 at the distal interphalangeal joint. The mean corrections of varus inclination and shortening were 31 ± 16 degrees and 3.1 ± 2.1 mm, respectively. American Orthopaedic Foot and Ankle Society scores significantly improved from 50 ± 2 preoperatively to 89 ± 8 at the final follow-up. There was 1 case of recurrence, floating toe deformity following pin tract infection in 1 case, and floating toe deformity without infection in 1 case.
Conclusion: We introduced dorsolateral closing wedge-shaped resection arthroplasty as a simple, effective, and powerful option for treating fixed, longstanding fourth curly toe deformity in adults
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NewsBot · Feb 14, 2020

Minimally invasive correction for symptomatic, fixed curly toe deformity
Dong JooLee et al
Foot and Ankle Surgery; 12 February 2020

Highlights
•We report the results of minimally invasive correction for symptomatic, fixed curly toe deformity.
•Percutaneous dorsolateral closing wedge-shaped osteotomies with Shannon burrs at the proximal and/or middle phalanx were performed.
•The mean amount of corrections of varus inclination and shortening were 16.54° and 2.24 mm.
•Minimally invasive dorsolateral closing wedge-shape osteotomy is a simple, safe, and effective correction for symptomatic, fixed curly toe deformity.
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Background
Curly toe deformity is a relatively common deformity that generally occurs at the 4th and 5th proximal and/or middle phalanges but rarely presents with symptoms. Although numerous open operative techniques have been introduced, there is no established treatment yet. We report the results of minimally invasive correction for symptomatic, fixed curly toe deformity.

Methods
Between 2016 and 2018, 25 consecutive percutaneous dorsolateral closing wedge-shaped osteotomies with Shannon burrs at the proximal and/or middle phalanx were performed. We assessed the postoperative clinical and radiological changes at a mean of 22.51 months of follow-up.

Results
The locations of osteotomy were at the middle phalanx in 10 cases, proximal phalanx in 13 cases, and both in one case. The mean amount of corrections of varus inclination and shortening were 16.54° and 2.24 mm, respectively. The Foot and Ankle Ability Measure Activities of Daily Living scores significantly improved from 59.09 preoperatively to 74.55 at the last follow-up. There was one case of pin site infection and one case of incision site numbness due to digital nerve injury.

Conclusions
Minimally invasive dorsolateral closing wedge-shape osteotomy is a simple, safe, and effective correction for symptomatic, fixed curly toe deformity.
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NewsBot · Sep 17, 2021

Assessment of the severity of curly toe
Hiroshi Satake et al
J Orthop Sci. 2021 Sep 6;S0949-2658(21)00267-0

Background: Curly/underlapping toe involves flexion, adduction, and varus deformity of the interphalangeal joints. There are no previous reports showing the relationship between physical examination and X-ray findings among patients with curly toe deformity.

Methods: We investigated the clinical findings of 116 consecutive patients associated with 239 underlapping toes. We compared the age and affected toes between patients whose deformities were pointed out at a pediatric medical examination (group 1) and those referred for medical treatment (group 2). The degree of curly toe deformity was graded by a physical examination and X-ray.

Results: The average age at presentation was 2.7 years. The affected toes were significantly different between groups 1 and 2 (p < .001). The morbidity of each toe differed significantly in group 2 (p < .005) but not in group 1. The correlation between the appearance grading and classification by X-ray was very strong using Spearman's rank correlation coefficient. The severity of curly toe was divided into mild in 104 toes, moderate in 105 toes, and severe in 17 toes. The methods of conservative treatment were observation only in 15 cases, manipulations in 30 cases, taping in 67 cases, and a brace in 9 cases. Surgery was performed in 8% of cases.

Conclusion: Curly toe deformity of the third or fourth toes tend to be referred for medical treatment because of the abnormality. Our grading system using a physical examination and classification by X-ray was useful for assessing the severity of curly toe.
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NewsBot · Oct 10, 2022

Effectiveness of minimally invasive surgery using incomplete phalangeal osteotomy for symptomatic curly toe of adults with a trapezoidal phalanx: An observational study
Leonor Ramírez-Andrés et al
Front Surg. 2022 Sep 20;9:965238

Background and aims: Digital deformity in flexion, varismus (external rotation), and adduction with the toe in both supraduction and infraduction are called clinocampodactyly or curly toe. All adult patients with symptoms and a diagnosis of semirigid/rigid curly toes underwent radiological examination to verify the presence of a trapezoidal phalanx. The purpose of this study was to quantitatively determine the degrees of improvement of a dysmetric phalanx after incomplete phalangeal osteotomy using minimally invasive surgery. The points of improvement were determined using the American Orthopedic Foot and Ankle Society (AOFAS) scale score.

Methods: Between May 2021 and June 2022, 30 patients diagnosed with curly toes underwent unicortical osteotomy of the affected phalanx. The convergence angle was measured and the AOFAS scale scores were compared.

Results: A total of 33 toes underwent surgery. The average reduction of the convergence angle was 9°. The average improvement in the AOFAS scale score was 53 points at 6 months and reached almost 90 points (89.9 ± 6.1 points).

Conclusions: Incomplete phalangeal osteotomy performed with minimally invasive surgery of the trapezoidal phalanges of curly toes of adults can improve alignment and AOFAS scale scores.
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